NCC232165_FRO Submitted_20230724

PLAN REVIEW/FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
CATAWBA COUNTY CODE OF ORDINANCES, CHAPTER 16 ARTICLE V
SOIL EROSION AND SEDIMENTATION CONTROL
No person may initiate any land-disturbing activity on one or more acres as covered by the Ordinance before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Catawba County
Utilities and Engineering Department. (Please type or print, and if question is not applicable,please N/A in the blank)
PART A
1. Job Name Towne Place Suites
2. PIN or 911 Address 371108986843
3. Purpose of development (residential, commercial, industrial, institutional,etc.) Commercial
4. Approximate soil disturbance date July 1,2023
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas) 2.50
6. Has an erosion and sedimentation control been filed? E Yes 1 No l Attached
7. If you have an Erosion Control billing account, would you like this to be billed? E yes l No
Account Number
PEOPLE
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity
Name Jack Sandlin E-mail address [e-mail]
Telephone Cell # 910-297-7605 Fax#
9. Landowner(s) of Record (attach accompanied page to list additional owners)
Name Sopps II LLC Telephone [phone] Fax #
Current Mailing Address 125 6th St NW
City Hickory State NC Zip 28601
Current Street Address 125 6th St NW
City Hickory State NC Zip 28601
10. Deed Book No. 2226 Page No. 1406
PART B
1. Person(s) or firm(s) who are financially responsible for the land-disturbing activity (Provide a comprehensive list
of all responsible parties on attached sheet):
Name Hickory Hospitality Ventures, LLC E-mail address [e-mail]
Current Mailing Address 107 Stokley Drive, Suite 100
City Wilmington State NC Zip I 28403

Current Street Address 107 Stokley Drive, Suite 100
City Wilmington State NC Zip 28403
Telephone [phone] Fax#
2. (a) If the financially responsible party is not a resident of North Carolina, give name and street address of the
designated North Carolina Agent:
Name E-mail address
Current Mailing Address
City State Zip
Current Street Address
City State Zip
Telephone Fax#
2. (b) If the financially responsible party is a Partnership or other person engaging in business under assumed name,
attach a copy of the Certificate of Assumed Name. If the financially responsible party is a Corporation, give name
and street address of the Registered Agent:
Name E-mail address
Current Mailing Address
City State Zip
Current Street Address
City State NC Zip
Telephone Fax#
The above information is true and correct to the best of my knowledge and belief and was provided by me under oath (This form
must be signed by the financially responsible person if an individual or his attorney - in -fact, or if not an individual, by an officer,
director, partner or registered agent with the authority to execute instruments for the financially responsible person). I agree to
provide corrected information should there be any change in the information provided herein.
John M. Sandlin Owner/Co-Managing Member
Type or Print Name Title of Authority
9.44.0r, 3'c.uieiiz �� 6-5-23
Signature Date
SA
I. Li .tpp
, , ���"'`'���, , a Notary Public of the County of �� Ra4IOI)t( State of North
Carolina, hereb;A tfy,-at;'alb $0.,n{k r% appeared personally before me this day and being duly
sworn ackno N$1e ;e vyas executed by him.
Witness mihard'and s 1,tH'is, U day of �/UIJL ,20 O�3
= m ' IAt I
Sea PUBLIC % z i {...4601.0j O)rI S
`,'. D 5 Notary'.,'9 i 7 I�tib�d�/07/202 J� My Commission expires /
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